不同刺激参数重复经颅磁刺激对抑郁症残留失眠症状的随机对照研究  

The effect of repetitive Transcranial Magnetic Stimulation(rTMS)at different stimulus parameters for residual insomnia symptoms in patients with major depressive disorder:a randomized,controlled study

作　　者：潘惠[1] 杨忠[1] 张小弟 杜向东[2] PAN Hui;YANG Zhong;ZHANG Xiaodi(The Third People’s Hospital of Changshu City, Changshu 215500, China)

机构地区：[1]常熟市第三人民医院,江苏常熟215500 [2]苏州大学附属广济医院

出　　处：《精神医学杂志》2021年第2期109-112,共4页Journal of Psychiatry

基　　金：江苏省高层次卫生人才“六个一工程”拔尖人才科研项目(编号:LGY 2020042);江苏省“333工程”科研资助项目(编号:BRA 2020120);常熟市科技发展计划(社会发展-医疗卫生类)项目(编号:CS 201512);苏州市临床重点病种诊疗专项项目(编号:LCZX 202016)。

摘　　要：目的比较不同参数重复经颅磁刺激(rTMS)对抑郁症残留失眠症状的疗效及安全性。方法将70例残留失眠症状的抑郁症患者采用随机数字表法分为高频组和低频组,每组35例,在原抗抑郁药基础上分别联用10 Hz或1 Hz的rTMS连续治疗4周。在基线期和治疗后第2、4周末采用17项汉密尔顿抑郁量表(HAMD-17)及匹兹堡睡眠质量指数量表(PSQI)评估疗效,治疗中需处理的不良反应症状量表(TESS)评估安全性。结果治疗后第2周末,两组HAMD-17总分及睡眠障碍因子分,低频组入睡困难、睡眠不深因子分均较各自基线期降低(P<0.05),且低频组睡眠障碍、入睡困难因子分低于高频组(P<0.05)。治疗后第4周末,两组HAMD-17总分及睡眠障碍、入睡困难、睡眠不深、早醒因子分均较各自基线期降低(P<0.05),且高频组HAMD-17总分及早醒因子分均低于低频组(P<0.05),入睡困难因子分高于低频组(P<0.05)。治疗后第4周末,两组PSQI总分及各因子分均较各自基线期降低(P<0.05),且高频组入睡时间因子分高于低频组(P<0.05),睡眠时间因子分低于低频组(P<0.05)。两组间不良反应发生率比较差异无统计学意义(P>0.05)。结论不同刺激参数rTMS均能有效治疗抑郁症残留失眠症状且右侧低频rTMS起效更快,左侧高频rTMS延长睡眠周期疗效更优。Objective To explore the efficacy and safety of repetitive Transcranial Magnetic Stimulation(rTMS)at different stimulus parameters in treating residual insomnia symptoms in patients with major depressive disorder.Methods A total of 70 depressive patients with residual insomnia symptoms were selected and randomly divided into high frequency group(n=35)treated with original antidepressants combined with 10 Hz rTMS and low frequency group(n=35)treated with original antidepressants combined with 1 Hz rTMS for 4 weeks.17-item Hamilton Depression Scale(HAMD-17),Pittsburgh Sleep Quality Index(PSQI)and Treatment Emergent Symptoms Scale(TESS)were used to assess the efficacy and safety at baseline and the 2nd,4th weekends after treatment.Results At the 2nd weekend after treatment,the total scores and factor scores of sleep disorder of HAMD-17 in both groups as well as the factor scores of insomnia-early and insomnia-middle in low frequency group decreased significantly compared with those at the baseline(P<0.05),and the factor scores of sleep disorder and insomnia-early in low frequency group were significantly lower than those in high frequency group(P<0.05).At the 4th weekend after treatment,the total scores and factor scores of sleep disorder,insomnia-early,insomnia-middle and insomnia-late of HAMD-17 in both groups decreased significantly compared with those at the baseline(P<0.05),and high frequency group showed lower total score and factor score of insomnia-late as well as higher factor score of insomnia-early than low frequency group(P<0.05).At the 4th weekend after treatment,the total scores and all factor scores of PSQI in both groups decreased significantly compared with those at the baseline(P<0.05),and high frequency group showed higher factor score of sleep latency as well as lower factor score of sleep time than low frequency group(P<0.05).There was no significant difference in the incidence rates of adverse reactions between two groups(P>0.05).Conclusion The use of rTMS at different stimulus parameters is ef

关 键 词：重复经颅磁刺激 不同刺激参数 抑郁症 残留症状 失眠 

分 类 号：R749.4[医药卫生—神经病学与精神病学]